5 research outputs found
Two distinct aetiologies of cardia cancer, evidence from premorbid serological markers of gastric atrophy and Helicobacter pylori status
Background: Non-cardia gastric adenocarcinoma is positively associated with Helicobacter pylori infection
and atrophic gastritis. The role of H pylori infection and atrophic gastritis in cardia cancer is unclear.
Aim: To compare cardia versus non-cardia cancer with respect to the premorbid state of the stomach.
Methods: Nested case–control study. To each of 129 non-cardia and 44 cardia cancers, three controls were
matched. Serum collected a median of 11.9 years before the diagnosis of cancer was tested for anti-H pylori
antibodies, pepsinogen I:II and gastrin.
Results: Non-cardia cancer was positively associated with H pylori (OR 4.75, 95% CI 2.56 to 8.81) and
gastric atrophy (pepsinogen I:II ,2.5; OR 4.47, 95% CI 2.71 to 7.37). The diffuse and intestinal histological
subtypes of non-cardia cancer were of similar proportions and both showed a positive association with
H pylori and atrophy. Cardia cancer was negatively associated with H pylori (OR 0.27, 95% CI 0.12 to
0.59), but H pylori-positive cardia cancer showed an association with gastric atrophy (OR 3.33, 95% CI 1.06
to 10.5). The predominant histological subtype of cardia cancer was intestinal and was not associated with
gastric atrophy compared with the diffuse subtype ((OR 0.72, 95% CI 0.19 to 2.79) vs (OR 3.46, 95% CI 0.32
to 37.5)). Cardia cancer in patients with atrophy had an intestinal: diffuse ratio (1:1) similar to non-cardia
cancer (1.9:1), whereas cardia cancers in patients without atrophy were predominantly intestinal (7:1).
Conclusion: These findings indicate two aetiologies of cardia cancer, one associated with H pylori atrophic
gastritis, resembling non-cardia cancer, and the other associated with non-atrophic gastric mucosa,
resembling oesophageal adenocarcinoma. Serological markers of gastric atrophy may provide the key to
determining gastric versus oesophageal origin of cardia cancer
Gastric cancer and Helicobacter pylori: a combined analysis of 12 case control studies nested within prospective cohorts
BACKGROUND: The magnitude of the association
between Helicobacter pylori and
incidence of gastric cancer is unclear. H
pylori infection and the circulating antibody
response can be lost with development
of cancer; thus retrospective studies
are subject to bias resulting from classifi-
cation of cases as H pylori negative when
they were infected in the past.
AIMS: To combine data from all case control
studies nested within prospective
cohorts to assess more reliably the relative
risk of gastric cancer associated with H
pylori infection.To investigate variation in
relative risk by age, sex, cancer type and
subsite, and interval between blood sampling
and cancer diagnosis.
METHODS: Studies were eligible if blood
samples for H pylori serology were collected
before diagnosis of gastric cancer in
cases. Identified published studies and two
unpublished studies were included. Individual
subject data were obtained for
each. Matched odds ratios (ORs) and 95%
confidence intervals (95% CI) were calculated
for the association between H pylori
and gastric cancer.
RESULTS: Twelve studies with 1228 gastric
cancer cases were considered. The association
with H pylori was restricted to noncardia
cancers (OR 3.0; 95% CI 2.3–3.8)
and was stronger when blood samples for
H pylori serology were collected 10+ years
before cancer diagnosis (5.9; 3.4–10.3). H
pylori infection was not associated with an
altered overall risk of cardia cancer (1.0;
0.7–1.4).
CONCLUSIONS: These results suggest that
5.9 is the best estimate of the relative risk
of non-cardia cancer associated with H
pylori infection and that H pylori does not
increase the risk of cardia cancer. They
also support the idea that when H pylori
status is assessed close to cancer diagnosis,
the magnitude of the non-cardia
association may be underestimated